With her 2015 DBT Skills Training Manual second edition, Marsha Linehan introduced a set of skills for addiction-related behaviors. These were added to the Distress Tolerance Module and are entitled, “When the Crisis is Addiction”. These skills focus on “backing down from addiction”. All of these skills, as well as all of DBT, is very compatible with 12 step and other supports for recovery from addictions.
Here is the subset of Distress Tolerance with some brief descriptions:
Dialectical Abstinence – This skill emphasizes the synthesis of two approaches for dealing with addictive behaviors: abstinence (completely swearing off of the addictive behavior) and harm reduction (acknowledging that there will be slips and minimizing the damage). You can count on DBT working with dialectics!
Clear Mind – The middle ground between the extremes of “addict mind” (being governed by an addiction) and “clean mind” (thinking that the problems of addiction are over and there is no need to worry any more). Clear mind is a bit like wise mind with specific reference to the ways we tend to think when we are working with addictive behaviors.
Community Reinforcement – This skill focuses on restructuring the environment so that it will reinforce abstinence instead of addiction. This can include sober friends and/or 12 step or other community recovery support networks.
Burning Bridges and Building New Ones – This refers to eliminating any and every connection to potential triggers for addictive behavior, including smells and other triggers and actively creating new non-addictive images and smells to focus on when you are having unwanted cravings. Non-addiction related visual and olfactory experiences are strong associations for addictions so it’s important to access different smells and create new images to associate with our new non-addictive behaviors.
Alternative Rebellion – It can be hard to give up an addiction when the addiction functions as some sort of rebellion. We need to find another rebellious but non-destructive behavior to substitute for the addictive behavior. Be creative here!
Adaptive Denial – Adamantly convincing yourself that you don’t want to engage in the addictive behavior when the urge strikes or that the addictive behavior is simply not an option. Repeat as needed.
Written By: Keren L Clark, LMFT
DBT-Linehan Board of Certification, Certified Clinician™
Image By: Shane Rounce on Unsplash
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